The literacy challenges of the medical dialogue are considerable and significant; as these challenges fall within the relatively unexplored domains of conceptual and oral literacy, they have been all but ignored in the exponentially growing literacy literature. Nevertheless, it is in the oral and conceptual literacy domains that critical issues arise in face-to-face interactions with health providers. It is here that the frustration grows in the accomplishment of the most basic of patient goals- to understand and be understood. There is reason to believe that these challenges are especially evident for low-literate women seeking prenatal care. Despite evidence of persistent socioeconomic and racial disparity in prenatal, perinatal, and post-partum services utilization and health outcomes, there has been relatively little federal focus on setting goals for the amelioration of literacy and health communication deficits affecting pregnant and post-partum women and their babies (Healthy People 2010), or in designing literacy interventions to improve health outcomes for this population. It is in the first prenatal visit that significant cognitive and emotional challenges are likely to arise in the complex information needed to make an informed choice about prenatal testing and in facing the psychosocial and emotional challenges of pregnancy. Consequently, it is the first visit that is likely to set the stage forfeiture exchanges and determine the relationship that develops, and the array of attitudinal, psychological, behavioral, and health outcomes that derive from care. The specific aims of the study are: (1) To understand the relationships among print, conceptual and oral literacy dimensions and to investigate the communication characteristics of deficits in these realms; (2) To work collaboratively with low-literate women, and health literacy experts, to develop a communication intervention designed to: (a) ameliorate oral and conceptual literacy deficits related to informed choice regarding prenatal genetic testing and (b)to facilitate disclosure and discussion about sensitive emotional and psychosocial topics, and (3) to conduct a randomized trial to evaluate the effect of the intervention on a variety of outcomes including: interaction, understanding, satisfaction, prenatal care utilization, post-partum appointment keeping, antenatal and post-partum depression symptoms, and pre-term deliveries.